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Objective To measure the expression levels of PD-1 and PD-L1 in the tumor tissues of patients with nasopharyngeal carcinoma ( NPC) and to explore the association of their expression with the clinical characteristics and prognosis of NPC patients. Methods The expression levels of PD-1 and PD-L1 in 65 NPC patients were determined by immunohistochemistry, and an analysis was performed on the association of their expression with clinical characteristics and long-term survival in NPC patients. Comparisons between groups were made by the chi-square test or Fisher′s exact test, and the Pearson' s test was used for correlation analysis. Survival rates were calculated using the Kaplan-Meier method, and the log-rank test was used for survival comparison and univariate prognostic analysis. The Cox model was used for multivariate prognostic analysis. Results Expression of PD-1 and PD-L1 was observed in 88%(57/65) and 89%( 58/65) of tumor cell surfaces using a cut-off value of 5%, and 38%( 25/65) and 58%( 38/65) using a cut-off value of 10%. PD-1 expression was significantly correlated with PD-L1 expression using the cut-off value of 5%( P=0003) , and a non-significant correlation was found between the expression levels of PD-1 and PD-L1 using the cut-off value of 10%(P=0080). There was no significant association between the positive expression rates of PD-1 and PD-L1 and clinicopathological characteristics ( P>005 ) . The univariate and multivariate survival analyses showed that using the cut-off value of 10%, the patients with positive PD-L1 expression had significantly reduced progression-free survival ( hazard ratio [ HR]=273, 95% confidence interval [ CI]:107-697, P=0035 ) and overall survival ( HR=395, 95%CI:109-1427, P=0036) compared with those with negative PD-L1 expression. Conclusions PD-1 and PD-L1 are highly expressed in NPC tissues. The expression of PD-L1 is associated with the poor prognosis in patients with stage IVa NPC, and PD-L1 can better predict the poor prognosis using the cut-off value of 10%.
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Objective To measure the expression levels of PD-1 and PD-L1 in the tumor tissues of patients with nasopharyngeal carcinoma ( NPC) and to explore the association of their expression with the clinical characteristics and prognosis of NPC patients. Methods The expression levels of PD-1 and PD-L1 in 65 NPC patients were determined by immunohistochemistry, and an analysis was performed on the association of their expression with clinical characteristics and long-term survival in NPC patients. Comparisons between groups were made by the chi-square test or Fisher′s exact test, and the Pearson' s test was used for correlation analysis. Survival rates were calculated using the Kaplan-Meier method, and the log-rank test was used for survival comparison and univariate prognostic analysis. The Cox model was used for multivariate prognostic analysis. Results Expression of PD-1 and PD-L1 was observed in 88%(57/65) and 89%( 58/65) of tumor cell surfaces using a cut-off value of 5%, and 38%( 25/65) and 58%( 38/65) using a cut-off value of 10%. PD-1 expression was significantly correlated with PD-L1 expression using the cut-off value of 5%( P=0003) , and a non-significant correlation was found between the expression levels of PD-1 and PD-L1 using the cut-off value of 10%(P=0080). There was no significant association between the positive expression rates of PD-1 and PD-L1 and clinicopathological characteristics ( P>005 ) . The univariate and multivariate survival analyses showed that using the cut-off value of 10%, the patients with positive PD-L1 expression had significantly reduced progression-free survival ( hazard ratio [ HR]=273, 95% confidence interval [ CI]:107-697, P=0035 ) and overall survival ( HR=395, 95%CI:109-1427, P=0036) compared with those with negative PD-L1 expression. Conclusions PD-1 and PD-L1 are highly expressed in NPC tissues. The expression of PD-L1 is associated with the poor prognosis in patients with stage IVa NPC, and PD-L1 can better predict the poor prognosis using the cut-off value of 10%.
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Objective To compare the long-term efficacy between two radiochemotherapy regimens for locally advanced nasopharyngeal carcinoma (NPC):intensity-modulated radiotherapy with concurrent chemotherapy (CCRT) versus neoadjuvant chemotherapy (NACT) followed by CCRT.Methods A retrospective analysis was performed on the clinical data of 278 patients with locally advanced NPC who were admitted to our hospital from 2001 to 2008.Of the 278 patients,133 received CCRT,and 145 received NACT followed by CCRT (NACT + CCRT).Results The follow-up rate was 96.6％.The 5-year overall survival (OS),distant metastasis-free survival (DMFS),recurrence-free survival (RFS),and progression-free survival (PFS) were 78.1％,78.0％,90.6％,and 72.0％,respectively.There were no significant differences between the CCRT group and NACT + CCRT group in 5-year OS (79.9％ vs.76.4％,P =0.443),DMFS (77.1％ vs.78.9％,P=0.972),RFS (91.6％ vs.89.8％,P=0.475),and PFS (71.6％ vs.72.2％,P=0.731).Subgroup analysis showed that compared with CCRT,NACT + CCRT did not significantly improve 5-year RFS in T3-4N0-1 patients (90.7％ vs.86.9％,P=0.376) and did not significantly improve 5-year DMFS in patients with advanced N-stage disease (57.6％ vs.69.7％,P =0.275).There were significantly higher numbers of individuals with neutropenia,decrease in hemoglobin,and upper gastrointestinal reactions in patients treated with NACT + CCRT than in those treated with CCRT (100 vs.52,P=0.000;64 vs.35,P=0.010;90 vs.63,P=0.044).Conclusions Compared with CCRT,NACT + CCRT does not significantly improve the prognosis in patients with locally advanced NPC and leads to significant increases in grade ≥ 3 toxicities (neutropenia,decrease in hemoglobin,and upper gastrointestinal reactions).The role of NACT in the treatment of locally advanced NPC needs further study
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Objective To retrospectively analyze the outcomes,adverse events,and prognostic factors in elderly patients initially diagnosed with nasopharyngeal carcinoma (NPC) who receive radiotherapy and chemotherapy.Methods From January 2004 to April 2007,202 patients (over 60 years of age) initially diagnosed with NPC received radical radiotherapy or chemotherapy.These patients included 165 males (81.7％) and 37 females (18.3％),with a median age of 65 years (range 60-86 years).Of all patients,1 had stage Ⅰ NPC,25 had stage Ⅱ NPC,120 had stage Ⅲ NPC,and 56 had stage Ⅳa/Ⅳb NPC,according to the AJCC staging system (6th edition).All patients received a radiation dose of ≥66 Gy,and 146 patients (72.3％) with locally advanced NPC also received chemotherapy.The Cox model was used for multivariate analysis.Results The follow-up rate was 100％.The 5-year local control rate,regional lymph node control rate,distant metastasis-free survival (DMFS) rate,disease-free survival rate,and overall survival (OS) rate were 93％,94％,82％,74％,and 67％,respectively.The multivariate analysis revealed that T stage,N stage,and age were prognostic factors for OS and DMFS (P =0.006,0.002,and 0.008 ;P =0.020,0.002,and 0.022).The severe acute toxicities included grade 4 radiation dermatitis (1 patient,0.5％),grade 4 radiation mucositis (2 patients,1.0％),and grade 4 bone marrow suppression (5 patients,2.5％).Conclusions The elderly NPC patients can tolerate radiotherapy and chemotherapy well.Multimodality therapy should be adopted for the patients aged 60-74 years who have advanced-stage NPC and good general conditions.
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Objective To evaluate the prognostic impact of MRI-detected prevertebral space involvement in nasopharyngeal carcinoma (NPC) treated with radiotherapy and chemotherapy.Methods A retrospective analysis was performed on the clinical data of 333 patients who had newly diagnosed biopsyproven NPC without distant metastasis from 2005 to 2007.All patients underwent MRI scans of the nasopharynx and neck and were treated with two-and three-dimensional radiotherapy without or without chemotherapy.The Kaplan-Meier method was used to calculate overall survival (OS),distant metastasis-free survival (DMFS),and locoregional relapse-free survival (LRFS),and the log-rank test was used for survival difference analysis;the Cox proportional hazards regression analysis was used to assess the prognostic value of prevertebral space involvement.Results The follow-up rate was 95.2％.Prevertebral space involvement was seen in 139(41.7％) of these patients.The patients with prevertebral space involvement had significantly higher T stage and clinical stage than those without prevertebral space involvement (x2 =90.41,P =0.000;x2 =54.03,P =0.000).The 5-year OS,DMFS,and LRFS for NPC patients with and without prevertebral space involvement were 58.8％ vs.77.5％ (x2 =11.95,P =0.000),77.8％ vs.85.0％(x2=2.56,P=0.110),and 88.3％ vs.91.8％ (x2=1.51,P=0.220),respectively.After adjusting for N stage,a significant difference was still seen between the two groups with regard to 5-year OS (x2 =9.93,P =0.002).The multivariate analysis showed that prevertebral space involvement was not the independent prognostic factor for OS,DMFS,and LRFS (x2 =0.43,P =0.512 ; x2 =0.08,P =0.783 ; x2 =0.00,P =0.971).Conclusions The frequency of prevertebral space involvement is very high in NPC.The OS for the patients with prevertebral space involvement is significantly lower than those without prevertebral space involvement.But prevertebral space involvement is not the independent prognostic factor in NPC patients.
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Objective To evaluate the long-term outcomes of patients with advanced N-stage nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy (IMRT) and the effects of IMRT combined with different chemotherapies on the patients' prognosis.Methods A retrospective analysis was performed on the clinical data of 179 patients with advanced N-stage NPC who were admitted to our hospital from January 2001 to January 2008.Of the 179 patients,33 received IMRT alone,and 146 received chemoradiotherapy (CRT).Among the 146 patients,71 received concurrent chemoradiotherapy (CCRT),66 received induction chemotherapy (IC) plus CCRT,and 9 received CCRT plus adjuvant chemotherapy (AC).Results The follow-up rate was 96.5％,and 133 patients were followed up for at least 5 years.The 5-year overall survival rate was 69.0％.The patients receiving IMRT alone and patients receiving CRT had 5-year overall survival rates of 47.7％ and 73.7％ (x2 =13.91,P =0.000),5-year distant metastasisfree survival (DMFS) rates of 49.2％ and 68.3％ (x2 =4.97,P =0.026),relapse-free survival rates of 74.5％ and 92.4％ (x2 =9.87,P =0.002),and progression-free survival rates of 37.5％ and 65.1％ (x2 =11.65,P =0.001).Among the patients receiving CRT,those receiving CCRT,IC plus CCRT,and CCRT plus AC had similar survival rates.IC plus CCRT resulted in a significantly higher DMFS than IMRT alone (x2 =4.65,P =0.031).Conclusions The distant metastasis rate is still high in patients with advanced N-stage NPC after IMRT,for whom IC plus concurrent chemotherapy and IMRT may be a better treatment regimen.
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Objective Nasopharyngeal carcinoma patients with stage N3 disease are prone to develop distant metastasis even treated with standard concurrent chemoradiotherapy(CRT).The aim of this study is to compare the ettlcacy of difierent chemotherapy sequences in these patients.Methotis All patients with histologically proven,carcinoma of the nasopharynx treated between July 1999 and November 2003 were restaged according to the AJCC 2002 stage classification system.A total of 114 patients had AJCC N3 diseases were analyzed retrospectively.Patients were treated by conventional RT technique using 6 MV photons or 60 Coγ-ray with 1.8-2.0 Gy per fraction,5 fractions a week,to a planned dose of 70 Gy.The prophylactic irradiation dose of the neck wss 54-60 Gy.Any positive lymph node was boosted to a total dose of 60-68 Gy.All patients received cisplatin-based chemotherapy of difierent sequences but 9 patients RT alone.CRT regimen was delivered in 37 patients,neoadjuvant chemotherapy(NACT)+CRT regimen in 53 patients and CRT+adjuvant chemotherapy(AC)regimen in 15 patients.Results The prophylactic irradiation dose of the neck wss 54-60 Gy.Any positive lymph node was boosted to a total dose of 60-68 Gy.All patients received cisplatin-based chemotherapy of difierent sequences but 9 patients received RT alone.CRT regimen was delivered in 37 patients,neoadjuvant chemotherapy(NACT)+CRT regimen in 53 patients and CRT+adjuvant chemotherapy(AC)regimen in 15 patients.Results The median follow up time was 54 months(3-117months).The 5-year overall survival rate was 59.1%in whole groups,and with 17%,51%,68%and 71%in RT,CRT,NACT+CRT and CRT+AC group,respectively(X2=15.44,P=0.001).The 5-year relapse-free survival rates were 83%,77%,88%and 93%in RT,CRT,NACT+CRT and CRT+AC group,respectively(X2=2.34,P=0.505).The 5-year metastasis-free survival rates were 17%,54%,72%and 80%in RT,CRT,NACT+CRT and CRT+AC group,respectively(X2=19.28,P=0.000).Conclusions The NACT+CRT and CRT+AC regimens were more effective than CRT alone for N3 disease in the current study.Large prospective,randomized clinieal studies are warranted.
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Objective To compare the efficacy of concurrent chemoradiotherapy versus radiotherapy alone for T3-4 N0-1 M0 and T14 N2-3 M0 nasopharyngeal carcinoma (NPC) after induction chemotherapy.Methods From 2002 to 2005,400 patients with stage Ⅲ and Ⅳa NPC were randomly divided into 2 groups :induction chemotherapy followed by concurrent chemoradiotherapy group (IC/CCRT,201 patients),and induction chemotherapy followed by radiotherapy alone group (IC/RT, 199 patients).Subgroup analysis was conducted for 197 patients with stage T3-4N0-1M0 NPC and 203 with stage T1-4N2-3M0 NPC.Results The follow-up rate were 96.2%, with a median followg-up time of 3.9 years.For T3-4N0-1 M0 NPC patients in IC/CCRT group (104 patients) and IC/RT group (93 patients), the 3-year overall survival, disease-free survival, locoregional recurrence-free survival and distant metastasis-free survival rates were 84.0% and 85.9% (χ2=0.08,P =0.780) ,77.0% and 72.0% (χ2=0.44,P =0.510) ,89.5% and 92.3% (χ2=0.65 ,P = 0.420), and 84.9% and 77.0% (χ2= 1.59, P = 0.210), respectively; For T1-4 N2-3 M0 NPC patients in IC/CCRT group (97 patients) and IC/RT group (106 patients), the corresponding rates were 67.4% and 82.2% (χ2=3.48,P=0.060), 61.5% and 68.0% (χ2= 1.86,P=0.170), 86.2% and 87.0% (χ2=0.57 ,P =0.450) and 66.2% and 75.6% (χ2=2.07 ,P =0.150), respectively.Acute sideeffects were similar except more leucocytopenia in IC/CCRT group than IC/RT group.Conclusions Compared with IC/RT, IC/CCRT dose not improve the overall survival in patients with T3-4N0-1 M0 and T1-4 N2-3 M0 NPC.